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Lee GW, Vine K, Atkinson AR, Tong M, Longman J, Barratt A, Bailie R, Vardoulakis S, Matthews V, Rahman KM. Impacts of Climate Change on Health and Health Services in Northern New South Wales, Australia: A Rapid Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6285. [PMID: 37444133 PMCID: PMC10341403 DOI: 10.3390/ijerph20136285] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023]
Abstract
Climate change is exposing populations to increasing temperatures and extreme weather events in many parts of Australia. To prepare for climate challenges, there is a growing need for Local Health Districts (LHDs) to identify potential health impacts in their region and strengthen the capacity of the health system to respond accordingly. This rapid review summarised existing evidence and research gaps on the impact of climate change on health and health services in Northern New South Wales (NSW)-a 'hotspot' for climate disaster declarations. We systematically searched online databases and selected 11 peer-reviewed studies published between 2012-2022 for the Northern NSW region. The most explored health outcome was mental health in the aftermath of floods and droughts, followed by increased healthcare utilisation due to respiratory, cardiovascular and mortality outcomes associated with bushfire smoke or heat waves. Future research directions were recommended to understand: the compounding impacts of extreme events on health and the health system, local data needs that can better inform models that predict future health risks and healthcare utilisation for the region, and the needs of vulnerable populations that require a whole-of-system response during the different phases of disasters. In conclusion, the review provided climate change and health research directions the LHD may undertake to inform future adaptation and mitigation policies and strategies relevant to their region.
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Affiliation(s)
- Grace W. Lee
- University of Sydney, University Centre for Rural Health, Lismore, NSW 2480, Australia; (G.W.L.); (K.V.); (A.-R.A.); (J.L.); (V.M.)
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia;
| | - Kristina Vine
- University of Sydney, University Centre for Rural Health, Lismore, NSW 2480, Australia; (G.W.L.); (K.V.); (A.-R.A.); (J.L.); (V.M.)
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
| | - Amba-Rose Atkinson
- University of Sydney, University Centre for Rural Health, Lismore, NSW 2480, Australia; (G.W.L.); (K.V.); (A.-R.A.); (J.L.); (V.M.)
- School of Public Health, Faculty of Medicine, the University of Queensland, St. Lucia, QLD 4072, Australia
| | - Michael Tong
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
- College of Health and Medicine, The Australian National University, Canberra, ACT 2601, Australia
| | - Jo Longman
- University of Sydney, University Centre for Rural Health, Lismore, NSW 2480, Australia; (G.W.L.); (K.V.); (A.-R.A.); (J.L.); (V.M.)
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
- Sydney Environment Institute, University of Sydney, Camperdown, NSW 2006, Australia
| | - Alexandra Barratt
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia;
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
| | - Ross Bailie
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
- School of Medicine, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Sotiris Vardoulakis
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
- College of Health and Medicine, The Australian National University, Canberra, ACT 2601, Australia
| | - Veronica Matthews
- University of Sydney, University Centre for Rural Health, Lismore, NSW 2480, Australia; (G.W.L.); (K.V.); (A.-R.A.); (J.L.); (V.M.)
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
| | - Kazi Mizanur Rahman
- University of Sydney, University Centre for Rural Health, Lismore, NSW 2480, Australia; (G.W.L.); (K.V.); (A.-R.A.); (J.L.); (V.M.)
- Sydney Environment Institute, University of Sydney, Camperdown, NSW 2006, Australia
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López-Bueno JA, Navas-Martín MA, Linares C, Mirón IJ, Luna MY, Sánchez-Martínez G, Culqui D, Díaz J. Analysis of the impact of heat waves on daily mortality in urban and rural areas in Madrid. ENVIRONMENTAL RESEARCH 2021; 195:110892. [PMID: 33607097 DOI: 10.1016/j.envres.2021.110892] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/25/2021] [Accepted: 02/12/2021] [Indexed: 06/12/2023]
Abstract
The objective of this study was to analyze and compare the effect of high temperatures on daily mortality in the urban and rural populations in Madrid. Data were analyzed from municipalities in Madrid with a population of over 10,000 inhabitants during the period from January 1, 2000 to December 31, 2020. Four groups were generated: Urban Metropolitan Center, Rural Northern Mountains, Rural Center, and Southern Rural. The dependent variable used was the rate of daily mortality due to natural causes per million inhabitants (CIE-X: A00-R99) between the months of June and September for the period. The primary independent variable was maximum daily temperature. Social and demographic "context variables" were included: population >64 years of age (%), deprivation index and housing indicators. The analysis was carried out in three phases: 1) determination of the threshold definition temperature of a heat wave (Tumbral) for each study group; 2) determination of relative risks (RR) attributable to heat for each group using Poisson linear regression (GLM), and 3) calculation of odds ratios (OR) using binomial family GLM for the frequency of the appearance of heat waves associated with context variables. The resulting percentiles (for the series of maximum daily temperatures for the summer months) corresponding to Tthreshold were: 74th percentile for Urban Metropolitan Center, 76th percentile for Southern Rural, 83rd for Rural Northern Mountains and 98th percentile for Center Rural (98). Greater vulnerability was found for the first two. In terms of context variables that explained the appearance of heat waves, deprivation index level, population >64 years of age and living in the metropolitan area were found to be risk factors. Rural and urban areas behaved differently, and socioeconomic inequality and the composition of the population over age 64 were found to best explain the vulnerability of the Rural Center and Southern Rural zones.
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Affiliation(s)
- J A López-Bueno
- National School of Public Health, Carlos III Institute of Health (ISCIII), Madrid, Spain.
| | - M A Navas-Martín
- National School of Public Health, Carlos III Institute of Health (ISCIII), Madrid, Spain
| | - C Linares
- National School of Public Health, Carlos III Institute of Health (ISCIII), Madrid, Spain
| | - I J Mirón
- Consejería de Sanidad, Junta de Comunidades de Castilla-La Mancha, Toledo, Spain
| | - M Y Luna
- State Meteorological Agency (AEMET), Madrid, Spain
| | | | - D Culqui
- National School of Public Health, Carlos III Institute of Health (ISCIII), Madrid, Spain
| | - J Díaz
- National School of Public Health, Carlos III Institute of Health (ISCIII), Madrid, Spain
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3
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López-Bueno JA, Díaz J, Sánchez-Guevara C, Sánchez-Martínez G, Franco M, Gullón P, Núñez Peiró M, Valero I, Linares C. The impact of heat waves on daily mortality in districts in Madrid: The effect of sociodemographic factors. ENVIRONMENTAL RESEARCH 2020; 190:109993. [PMID: 32745539 DOI: 10.1016/j.envres.2020.109993] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/09/2020] [Accepted: 07/23/2020] [Indexed: 06/11/2023]
Abstract
Although there is significant scientific evidence on the impact of heat waves, there are few studies that analyze the effects of sociodemographic factors on the impact of heat waves below the municipal level. The objective of this study was to analyze the role of income level, percent of the population over age 65, existence of air conditioning units and hectares (Ha) of green zones in districts in Madrid, in the impact of heat on daily mortality between January 1, 2010 and December 31, 2013. Seventeen districts were analyzed, and Generalized Linear (GLM) Poisson Regression Models were used to calculate relative risks (RR) and attributable risks (RA) for the impact of heat waves on mortality due to natural causes (CIEX:A00-R99). The pattern of risks obtained was analyzed using GLM univariates and multivariates of the binomial family (link logit), introducing the socioeconomic and demographic variables mentioned above. The results indicate that heat wave had an impact in only three of the districts analyzed. In the univariate models, all of the variables were statistically significant, but Ha of green zones lost significance in the multivariate model. Income level, existence of air conditioning units, and percent of the population over age 65 in the district remained as variables that modulate the impact of heat wave on daily mortality in the municipality of Madrid. Income level was the key variable that explained this behavior. The results obtained in this study show that there are factors at levels below the municipal level (district level) that should be considered as focus areas for health policy in order to decrease the impact of heat and promote the process of adaptation to heat in the context of climate change.
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Affiliation(s)
- J A López-Bueno
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Spain
| | - J Díaz
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Spain.
| | - C Sánchez-Guevara
- Escuela Técnica Superior de Arquitectura, Universidad Politécnica de Madrid, Spain
| | | | - M Franco
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcala, Alcala de Henares, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - P Gullón
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcala, Alcala de Henares, Madrid, Spain
| | - M Núñez Peiró
- Escuela Técnica Superior de Arquitectura, Universidad Politécnica de Madrid, Spain
| | - I Valero
- Escuela Técnica Superior de Arquitectura, Universidad Politécnica de Madrid, Spain
| | - C Linares
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Spain
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Schnitter R, Verret M, Berry P, Chung Tiam Fook T, Hales S, Lal A, Edwards S. An Assessment of Climate Change and Health Vulnerability and Adaptation in Dominica. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:E70. [PMID: 30597870 PMCID: PMC6339242 DOI: 10.3390/ijerph16010070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/18/2018] [Accepted: 12/23/2018] [Indexed: 12/17/2022]
Abstract
A climate change and health vulnerability and adaptation assessment was conducted in Dominica, a Caribbean small island developing state located in the Lesser Antilles. The assessment revealed that the country's population is already experiencing many impacts on health and health systems from climate variability and change. Infectious diseases as well as food and waterborne diseases pose continued threats as climate change may exacerbate the related health risks. Threats to food security were also identified, with particular concern for food production systems. The findings of the assessment included near-term and long-term adaptation options that can inform actions of health sector decision-makers in addressing health vulnerabilities and building resilience to climate change. Key challenges include the need for enhanced financial and human resources to build awareness of key health risks and increase adaptive capacity. Other small island developing states interested in pursuing a vulnerability and adaptation assessment may find this assessment approach, key findings, analysis, and lessons learned useful.
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Affiliation(s)
- Rebekka Schnitter
- Climate Change and Innovation Bureau, Health Canada, Ottawa, ON K1A 0P8, Canada.
| | - Marielle Verret
- Climate Change and Innovation Bureau, Health Canada, Ottawa, ON K1A 0P8, Canada.
| | - Peter Berry
- Climate Change and Innovation Bureau, Health Canada, Ottawa, ON K1A 0P8, Canada.
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
| | - Tanya Chung Tiam Fook
- Faculty of Environmental Studies and Dahdaleh Institute for Global Health Research, York University, Toronto, ON M3J 1P3, Canada.
| | - Simon Hales
- Department of Public Health, University of Otago, Newtown, Wellington 6242, New Zealand.
| | - Aparna Lal
- Research School of Population Health, Australian National University, Acton, Canberra 2600, Australia.
| | - Sally Edwards
- Pan American Health Organization, Washington, DC 20037, USA.
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Vicedo-Cabrera AM, Guo Y, Sera F, Huber V, Schleussner CF, Mitchell D, Tong S, Coelho MDSZS, Saldiva PHN, Lavigne E, Correa PM, Ortega NV, Kan H, Osorio S, Kyselý J, Urban A, Jaakkola JJK, Ryti NRI, Pascal M, Goodman PG, Zeka A, Michelozzi P, Scortichini M, Hashizume M, Honda Y, Hurtado-Diaz M, Cruz J, Seposo X, Kim H, Tobias A, Íñiguez C, Forsberg B, Åström DO, Ragettli MS, Röösli M, Guo YL, Wu CF, Zanobetti A, Schwartz J, Bell ML, Dang TN, Do Van D, Heaviside C, Vardoulakis S, Hajat S, Haines A, Armstrong B, Ebi KL, Gasparrini A. Temperature-related mortality impacts under and beyond Paris Agreement climate change scenarios. CLIMATIC CHANGE 2018; 150:391-402. [PMID: 30405277 PMCID: PMC6217994 DOI: 10.1007/s10584-018-2274-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/03/2018] [Indexed: 05/22/2023]
Abstract
The Paris Agreement binds all nations to undertake ambitious efforts to combat climate change, with the commitment to Bhold warming well below 2 °C in global mean temperature (GMT), relative to pre-industrial levels, and to pursue efforts to limit warming to 1.5 °C". The 1.5 °C limit constitutes an ambitious goal for which greater evidence on its benefits for health would help guide policy and potentially increase the motivation for action. Here we contribute to this gap with an assessment on the potential health benefits, in terms of reductions in temperature-related mortality, derived from the compliance to the agreed temperature targets, compared to more extreme warming scenarios. We performed a multi-region analysis in 451 locations in 23 countries with different climate zones, and evaluated changes in heat and cold-related mortality under scenarios consistent with the Paris Agreement targets (1.5 and 2 °C) and more extreme GMT increases (3 and 4 °C), and under the assumption of no changes in demographic distribution and vulnerability. Our results suggest that limiting warming below 2 °C could prevent large increases in temperature-related mortality in most regions worldwide. The comparison between 1.5 and 2 °C is more complex and characterized by higher uncertainty, with geographical differences that indicate potential benefits limited to areas located in warmer climates, where direct climate change impacts will be more discernible.
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Affiliation(s)
- Ana Maria Vicedo-Cabrera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC 3004 Australia
- Division of Epidemiology and Biostatistics, School of Population Health, University of Queensland, St Lucia, Brisbane, QLD 4072 Australia
| | - Francesco Sera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Veronika Huber
- Potsdam Institute for Climate Impact Research, Telegrafenberg, 14473 Potsdam, Germany
- Universidad Pablo de Olavide, Carretera de Utrera, 41013 Sevilla, Spain
| | - Carl-Friedrich Schleussner
- Potsdam Institute for Climate Impact Research, Telegrafenberg, 14473 Potsdam, Germany
- Climate Analytics, Ritterstraße 3, 10969 Berlin, Germany
| | - Dann Mitchell
- School of Geographical Sciences, University of Bristol, University Road, Bristol, BS8 1SS UK
| | - Shilu Tong
- School of Public Health and Institute of Environment and Human Health, Anhui Medical University, Meishan Road, Hefei, 81 230032 China
- Shanghai Children’s Medical Centre, Shanghai Jiao-Tong University, 1678 Dongfang Rd, Shanghai, 200127 China
- School of Public Health and Social Work, Queensland University of Technology, 2 George St, Brisbane City, QLD 4000 Australia
| | | | - Paulo Hilario Nascimento Saldiva
- Institute of Advanced Studies, University of São Paulo, Rua Praça do Relógio, 109, Building K, 5th floor, Cidade Universitária, ZC, São Paulo, São Paulo 05508-970 Brazil
| | - Eric Lavigne
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, K1G 5Z3 Canada
- Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Canada
| | - Patricia Matus Correa
- Department of Public Health, Universidad de los Andes, Mons. Alvaro del Portillo 12, 455 Santiago, Chile
| | - Nicolas Valdes Ortega
- Department of Public Health, Universidad de los Andes, Mons. Alvaro del Portillo 12, 455 Santiago, Chile
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, 138 Yi xue yuan Road, Shanghai, 200032 China
| | - Samuel Osorio
- Department of Environmental Health, University of São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, São Paulo 03178-200 Brazil
| | - Jan Kyselý
- Institute of Atmospheric Physics, Academy of Sciences of the Czech Republic, Bocni, 1401 14131 Prague, Czech Republic
- Faculty of Environmental Sciences, Czech University of Life Sciences, Kamycka, 129 16521 Prague, Czech Republic
| | - Aleš Urban
- Institute of Atmospheric Physics, Academy of Sciences of the Czech Republic, Bocni, 1401 14131 Prague, Czech Republic
| | - Jouni J. K. Jaakkola
- Center for Environmental and Respiratory Health Research, University of Oulu, Aapistie 5B, FI-90014 Oulu, Finland
| | - Niilo R. I. Ryti
- Center for Environmental and Respiratory Health Research, University of Oulu, Aapistie 5B, FI-90014 Oulu, Finland
| | - Mathilde Pascal
- Santé Publique France, French National Public Health Agency, 12 rue du Val d’Osne, 94415 Saint Maurice, France
| | - Patrick G. Goodman
- School of Physics, Dublin Institute of Technology, Kevin Street 2, Dublin, D08 X622 Ireland
| | - Ariana Zeka
- Institute of Environment, Health and Societies, Brunel University London, Kingston Ln, Uxbridge, London, UB8 3PH UK
| | - Paola Michelozzi
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo, 112 00147 Rome, Italy
| | - Matteo Scortichini
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo, 112 00147 Rome, Italy
| | - Masahiro Hashizume
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto Nagasaki, Nagasaki, 852-8523 Japan
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8574 Japan
| | - Magali Hurtado-Diaz
- Department of Environmental Health, National Institute of Public Health, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos Mexico
| | - Julio Cruz
- Department of Environmental Health, National Institute of Public Health, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos Mexico
| | - Xerxes Seposo
- Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoudai Katsura Campus, Nishikyou Ward, Kyoto, 615-8540 Japan
- Department of Global Ecology, Graduate School of Global Environmental Studies, Yoshidahonmachi, Sakyo Ward, Kyoto, 606-8501 Japan
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, 1Gwanak-ro Gwanak-gu, Seoul, 08826 Republic of Korea
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Jordi Girona 18-26, 08034 Barcelona, Spain
| | - Carmen Íñiguez
- Department of Statistics and Computational Research, Environmental Health Joint Research Unit FISABIO-UV-UJI CIBERESP, University of Valencia, Valencia, Spain
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, 901 85 Umeå, Sweden
| | - Daniel Oudin Åström
- Department of Public Health and Clinical Medicine, Umeå University, 901 85 Umeå, Sweden
| | - Martina S. Ragettli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
- University of Basel, Petersplatz 1, 4001 Basel, Switzerland
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
- University of Basel, Petersplatz 1, 4001 Basel, Switzerland
| | - Yue Leon Guo
- Environmental and Occupational Medicine, and Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University (NTU) and NTU Hospital, 1 Section 4, Roosevelt Rd, Da’an District, Taipei, Taiwan
| | - Chang-fu Wu
- National Institute of Environmental Health Sciences, National Health Research Institutes, 35 Keyan Road, 35053 Zhunan, Taiwan
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA
| | - Michelle L. Bell
- School of Forestry and Environmental Studies, Yale University, 195 Prospect St, New Haven, CT 06511 USA
| | - Tran Ngoc Dang
- Faculty of Public Health, University of Medicine and Pharmacy, Ho Chi Minh city, 217 Hồng Bàng, Phường 11, Quận 5, Ho Chi Minh City, Vietnam
- Institute of Research and Development, Duy Tan University, 254 Nguyễn Văn Linh, Thạc Gián, Q. Thanh Khê, Da Nang, Vietnam
| | - Dung Do Van
- Faculty of Public Health, University of Medicine and Pharmacy, Ho Chi Minh city, 217 Hồng Bàng, Phường 11, Quận 5, Ho Chi Minh City, Vietnam
| | - Clare Heaviside
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
- Chemical and Environmental Effects, Centre for Radiation, Chemical & Environmental Hazards, Public Health England, Didcot Oxon, Chilton, London, OX11 0RQ UK
| | - Sotiris Vardoulakis
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
- Institute of Occupational Medicine, Research Avenue North, Riccarton, Edinburgh, EH14 4AP UK
| | - Shakoor Hajat
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Andy Haines
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Ben Armstrong
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Kristie L. Ebi
- Center for Health and the Global Environment (CHanGE), University of Washington, Seattle, WA 98105 USA
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
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Krieger N, Davey Smith G. The tale wagged by the DAG: broadening the scope of causal inference and explanation for epidemiology. Int J Epidemiol 2018; 45:1787-1808. [PMID: 27694566 DOI: 10.1093/ije/dyw114] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 12/31/2022] Open
Abstract
'Causal inference', in 21st century epidemiology, has notably come to stand for a specific approach, one focused primarily on counterfactual and potential outcome reasoning and using particular representations, such as directed acyclic graphs (DAGs) and Bayesian causal nets. In this essay, we suggest that in epidemiology no one causal approach should drive the questions asked or delimit what counts as useful evidence. Robust causal inference instead comprises a complex narrative, created by scientists appraising, from diverse perspectives, different strands of evidence produced by myriad methods. DAGs can of course be useful, but should not alone wag the causal tale. To make our case, we first address key conceptual issues, after which we offer several concrete examples illustrating how the newly favoured methods, despite their strengths, can also: (i) limit who and what may be deemed a 'cause', thereby narrowing the scope of the field; and (ii) lead to erroneous causal inference, especially if key biological and social assumptions about parameters are poorly conceived, thereby potentially causing harm. As an alternative, we propose that the field of epidemiology consider judicious use of the broad and flexible framework of 'inference to the best explanation', an approach perhaps best developed by Peter Lipton, a philosopher of science who frequently employed epidemiologically relevant examples. This stance requires not only that we be open to being pluralists about both causation and evidence but also that we rise to the challenge of forging explanations that, in Lipton's words, aspire to 'scope, precision, mechanism, unification and simplicity'.
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Affiliation(s)
- Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - George Davey Smith
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
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Bardosh KL, Ryan SJ, Ebi K, Welburn S, Singer B. Addressing vulnerability, building resilience: community-based adaptation to vector-borne diseases in the context of global change. Infect Dis Poverty 2017; 6:166. [PMID: 29228986 PMCID: PMC5725972 DOI: 10.1186/s40249-017-0375-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 11/15/2017] [Indexed: 11/14/2022] Open
Abstract
Background The threat of a rapidly changing planet – of coupled social, environmental and climatic change – pose new conceptual and practical challenges in responding to vector-borne diseases. These include non-linear and uncertain spatial-temporal change dynamics associated with climate, animals, land, water, food, settlement, conflict, ecology and human socio-cultural, economic and political-institutional systems. To date, research efforts have been dominated by disease modeling, which has provided limited practical advice to policymakers and practitioners in developing policies and programmes on the ground. Main body In this paper, we provide an alternative biosocial perspective grounded in social science insights, drawing upon concepts of vulnerability, resilience, participation and community-based adaptation. Our analysis was informed by a realist review (provided in the Additional file 2) focused on seven major climate-sensitive vector-borne diseases: malaria, schistosomiasis, dengue, leishmaniasis, sleeping sickness, chagas disease, and rift valley fever. Here, we situate our analysis of existing community-based interventions within the context of global change processes and the wider social science literature. We identify and discuss best practices and conceptual principles that should guide future community-based efforts to mitigate human vulnerability to vector-borne diseases. We argue that more focused attention and investments are needed in meaningful public participation, appropriate technologies, the strengthening of health systems, sustainable development, wider institutional changes and attention to the social determinants of health, including the drivers of co-infection. Conclusion In order to respond effectively to uncertain future scenarios for vector-borne disease in a changing world, more attention needs to be given to building resilient and equitable systems in the present. Electronic supplementary material The online version of this article (doi: 10.1186/s40249-017-0375-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kevin Louis Bardosh
- Department of Anthropology, University of Florida, Gainesville, USA. .,Emerging Pathogens Institute, University of Florida, Gainesville, USA.
| | - Sadie J Ryan
- Emerging Pathogens Institute, University of Florida, Gainesville, USA.,Department of Geography, University of Florida, Gainesville, USA
| | - Kris Ebi
- Department of Global Health, University of Washington, Seattle, USA
| | - Susan Welburn
- Centre of Infectious Disease, University of Edinburgh, Edinburgh, UK
| | - Burton Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, USA
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Chang KM, Hess JJ, Balbus JM, Buonocore JJ, Cleveland DA, Grabow ML, Neff R, Saari RK, Tessum CW, Wilkinson P, Woodward A, Ebi KL. Ancillary health effects of climate mitigation scenarios as drivers of policy uptake: a review of air quality, transportation and diet co-benefits modeling studies. ENVIRONMENTAL RESEARCH LETTERS : ERL [WEB SITE] 2017; 12:113001. [PMID: 38605885 PMCID: PMC11007749 DOI: 10.1088/1748-9326/aa8f7b] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Background Significant mitigation efforts beyond the Nationally Determined Commitments (NDCs) coming out of the 2015 Paris Climate Agreement are required to avoid warming of 2°C above pre-industrial temperatures. Health co-benefits represent selected near term, positive consequences of climate policies that can offset mitigation costs in the short term before the beneficial impacts of those policies on the magnitude of climate change are evident. The diversity of approaches to modeling mitigation options and their health effects inhibits meta-analyses and syntheses of results useful in policy-making. Methods/Design We evaluated the range of methods and choices in modeling health co-benefits of climate mitigation to identify opportunities for increased consistency and collaboration that could better inform policy-making. We reviewed studies quantifying the health co-benefits of climate change mitigation related to air quality, transportation, and diet published since the 2009 Lancet Commission 'Managing the health effects of climate change' through January 2017. We documented approaches, methods, scenarios, health-related exposures, and health outcomes. Results/Synthesis Forty-two studies met the inclusion criteria. Air quality, transportation, and diet scenarios ranged from specific policy proposals to hypothetical scenarios, and from global recommendations to stakeholder-informed local guidance. Geographic and temporal scope as well as validity of scenarios determined policy relevance. More recent studies tended to use more sophisticated methods to address complexity in the relevant policy system. Discussion Most studies indicated significant, nearer term, local ancillary health benefits providing impetus for policy uptake and net cost savings. However, studies were more suited to describing the interaction of climate policy and health and the magnitude of potential outcomes than to providing specific accurate estimates of health co-benefits. Modeling the health co-benefits of climate policy provides policy-relevant information when the scenarios are reasonable, relevant, and thorough, and the model adequately addresses complexity. Greater consistency in selected modeling choices across the health co-benefits of climate mitigation research would facilitate evaluation of mitigation options particularly as they apply to the NDCs and promote policy uptake.
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Affiliation(s)
- Kelly M Chang
- University of Washington Center for Health and the Global Environment, Seattle, WA 98105, United States of America
| | - Jeremy J Hess
- University of Washington Center for Health and the Global Environment, Seattle, WA 98105, United States of America
| | - John M Balbus
- National Institute of Environmental Health Sciences, Durham, NC, United States of America
| | - Jonathan J Buonocore
- Center for Health and the Global Environment, Harvard School of Public Health, Landmark Center 4th Floor, Suite 415, 401 Park Drive, Boston, MA 02215, United States of America
| | - David A Cleveland
- University of California Santa Barbara, Santa Barbara, CA, United States of America
| | - Maggie L Grabow
- Family Medicine and Community Health, University of Wisconsin Madison School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715, United States of America
| | - Roni Neff
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America
| | | | | | - Paul Wilkinson
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | | | - Kristie L Ebi
- LLC, ClimAdapt, 424 Tyndall Street, Los Altos, CA 94022, United States of America
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9
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Sheehan MC, Fox MA, Kaye C, Resnick B. Integrating Health into Local Climate Response: Lessons from the U.S. CDC Climate-Ready States and Cities Initiative. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:094501. [PMID: 28934724 PMCID: PMC5915203 DOI: 10.1289/ehp1838] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 05/03/2023]
Abstract
Public health has potential to serve as a frame to convey the urgency of behavior change needed to adapt to a changing climate and reduce greenhouse gas emissions. Local governments form the backbone of climate-related public health preparedness. Yet local health agencies are often inadequately prepared and poorly integrated into climate change assessments and plans. We reviewed the climate health profiles of 16 states and two cities participating in the U.S. Centers for Disease Control and Prevention (CDC)'s Climate-Ready States and Cities Initiative (CRSCI) that aims to build local capacity to assess and respond to the health impacts of climate change. Following recommendations from a recent expert panel strategic review, we present illustrations of emerging promising practice and future directions. We found that CRSCI has strengthened climate preparedness and response in local public health agencies by identifying critical climate-health impacts and vulnerable populations, and has helped integrate health more fully into broader climate planning. Promising practice was found in all three recommendation areas identified by the expert panel (leveraging partnerships, refining assessment methodologies and enhancing communications), particularly with regard to health impacts of extreme heat. Vast needs remain, however, suggesting the need to disseminate CRSCI experience to non-grantees. In conclusion, the CRSCI program approach and selected activities illustrate a way forward toward robust, targeted local preparedness and response that may serve as a useful example for public health departments in the United States and internationally, particularly at a time of uncertain commitment to climate change agreements at the national level. https://doi.org/10.1289/EHP1838.
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Affiliation(s)
- Mary C Sheehan
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, Maryland, USA
| | - Mary A Fox
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, Maryland, USA
| | - Charlotte Kaye
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, Maryland, USA
| | - Beth Resnick
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, Maryland, USA
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10
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Aleeban M, Mackey TK. Global Health and Visa Policy Reform to Address Dangers of Hajj during Summer Seasons. Front Public Health 2016; 4:280. [PMID: 28066758 PMCID: PMC5177611 DOI: 10.3389/fpubh.2016.00280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 12/07/2016] [Indexed: 11/25/2022] Open
Abstract
Every year on the 12th month of the Islamic calendar, 2–3 million Muslims from over 160 countries migrate to Holy sites in Saudi Arabia to perform the Hajj, representing one of the largest mass gathering events worldwide. Yet, the Hajj poses several challenges to global health and public safety, including the unique health risks posed by seasonal variability when Hajj occurs during summer months. Specifically, pilgrims taking the journey to Mecca are at higher risk for heat illnesses, heat-related injuries and exhaustion, and stampedes, when summer temperatures can reach up to 48.7°C. In response, we propose that the Saudi government, in coordination with the Organization of Islamic Cooperation and the World Health Organization, explore the establishment of an expert committee, create and use a predictive risk modeling tool, and establish a dynamic quota on Hajj visas to limit potential heat exposure for high-risk populations when the Hajj falls on seasons associated with extreme weather exposure. As climate change is projected to lead to future increases in temperatures in the region, this form of dynamic and evidence-based policymaking is needed to ensure human health and safety for generations of Hajj pilgrims to come.
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Affiliation(s)
- Mohanad Aleeban
- Joint Masters Degree Program in Health Policy and Law, University of California San Diego School of Medicine - California Western School of Law, San Diego, CA, USA; King Fahad Medical City, Riyadh, Saudi Arabia
| | - Tim K Mackey
- Joint Masters Degree Program in Health Policy and Law, University of California San Diego School of Medicine - California Western School of Law, San Diego, CA, USA; Department of Anesthesiology, University of California San Diego School of Medicine, San Diego, CA, USA; Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine, San Diego, CA, USA; Global Health Policy Institute, San Diego, CA, USA
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11
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Ebi KL, Hess JJ, Isaksen TB. Using Uncertain Climate and Development Information in Health Adaptation Planning. Curr Environ Health Rep 2016; 3:99-105. [PMID: 26814795 DOI: 10.1007/s40572-016-0077-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
To aid health adaptation decision-making, there are increasing efforts to provide climate projections at finer temporal and spatial scales. Relying solely on projected climate changes for longer-term decisions makes the implicit assumption that sources of vulnerability other than climate change will remain the same, which is not very probable. Over longer time horizons, this approach likely over estimates the extent to which climate change could alter the magnitude and pattern of health outcomes, introducing systematic bias into health management decisions. To balance this potential bias, decision-makers also need projections of other drivers of health outcomes that are, like climate change, recognized determinants of some disease burdens. Incorporating projections via an iterative process that allows for regular updates based on new knowledge and experience has the potential to improve the utility of fine-scale climate projections in health system adaptation to climate change.
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Affiliation(s)
- Kristie L Ebi
- School of Public Health, University of Washington, 4225 Roosevelt Way NE #100, Seattle, WA, 98105, USA.
| | - Jeremy J Hess
- School of Public Health, University of Washington, 4225 Roosevelt Way NE #100, Seattle, WA, 98105, USA.,School of Medicine, University of Washington, Seattle, WA, USA
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12
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Ebi KL, Semenza JC, Rocklöv J. Current medical research funding and frameworks are insufficient to address the health risks of global environmental change. Environ Health 2016; 15:108. [PMID: 27835959 PMCID: PMC5106817 DOI: 10.1186/s12940-016-0183-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 10/10/2016] [Indexed: 05/27/2023]
Abstract
BACKGROUND Three major international agreements signed in 2015 are key milestones for transitioning to more sustainable and resilient societies: the UN 2030 Agenda for Sustainable Development; the Sendai Framework for Disaster Risk Reduction; and the Paris Agreement under the United Nations Framework Convention on Climate Change. Together, these agreements underscore the critical importance of understanding and managing the health risks of global changes, to ensure continued population health improvements in the face of significant social and environmental change over this century. BODY: Funding priorities of major health institutions and organizations in the U.S. and Europe do not match research investments with needs to inform implementation of these international agreements. In the U.S., the National Institutes of Health commit 0.025 % of their annual research budget to climate change and health. The European Union Seventh Framework Programme committed 0.08 % of the total budget to climate change and health; the amount committed under Horizon 2020 was 0.04 % of the budget. Two issues apparently contributing to this mismatch are viewing climate change primarily as an environmental problem, and therefore the responsibility of other research streams; and narrowly framing research into managing the health risks of climate variability and change from the perspective of medicine and traditional public health. This reductionist, top-down perspective focuses on proximate, individual level risk factors. While highly successful in reducing disease burdens, this framing is insufficient to protect health and well-being over a century that will be characterized by profound social and environmental changes. CONCLUSIONS International commitments in 2015 underscored the significant challenges societies will face this century from climate change and other global changes. However, the low priority placed on understanding and managing the associated health risks by national and international research institutions and organizations leaves populations poorly prepared to cope with changing health burdens. Risk-centered, systems approaches can facilitate understanding of the complex interactions and dependencies across environmental, social, and human systems. This understanding is needed to formulate effective interventions targeting socio-environmental factors that are as important for determining health burdens as are individual risk factors.
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Affiliation(s)
- Kristie L Ebi
- Department of Global Health, University of Washington, Seattle, WA, 98195, USA.
| | - Jan C Semenza
- Stockholm Environmental Institute, Linnégatan 87D, 115 23, Stockholm, Sweden
| | - Joacim Rocklöv
- Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
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McIver L, Hashizume M, Kim H, Honda Y, Pretrick M, Iddings S, Pavlin B. Assessment of Climate-sensitive Infectious Diseases in the Federated States of Micronesia. Trop Med Health 2014; 43:29-40. [PMID: 25859151 PMCID: PMC4361343 DOI: 10.2149/tmh.2014-17] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 10/31/2014] [Indexed: 12/22/2022] Open
Abstract
Background: The health impacts of climate change are an issue of growing concern in the Pacific region. Prior to 2010, no formal, structured, evidence-based approach had been used to identify the most significant health risks posed by climate change in Pacific island countries. During 2010 and 2011, the World Health Organization supported the Federated States of Micronesia (FSM) in performing a climate change and health vulnerability and adaptation assessment. This paper summarizes the priority climate-sensitive health risks in FSM, with a focus on diarrheal disease, its link with climatic variables and the implications of climate change. Methods: The vulnerability and adaptation assessment process included a review of the literature, extensive stakeholder consultations, ranking of climate-sensitive health risks, and analysis of the available long-term data on climate and climate-sensitive infectious diseases in FSM, which involved examination of health information data from the four state hospitals in FSM between 2000 and 2010; along with each state’s rainfall, temperature and El Niño-Southern Oscillation data. Generalized linear Poisson regression models were used to demonstrate associations between monthly climate variables and cases of climate-sensitive diseases at differing temporal lags. Results: Infectious diseases were among the highest priority climate-sensitive health risks identified in FSM, particularly diarrheal diseases, vector-borne diseases and leptospirosis. Correlation with climate data demonstrated significant associations between monthly maximum temperature and monthly outpatient cases of diarrheal disease in Pohnpei and Kosrae at a lag of one month and 0 to 3 months, respectively; no such associations were observed in Chuuk or Yap. Significant correlations between disease incidence and El Niño-Southern Oscillation cycles were demonstrated in Kosrae state. Conclusions: Analysis of the available data demonstrated significant associations between climate variables and climate-sensitive infectious diseases. This information should prove useful in implementing health system and community adaptation strategies to avoid the most serious impacts of climate change on health in FSM.
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Affiliation(s)
- Lachlan McIver
- National Centre for Epidemiology and Population Health, Australian National University , Canberra, Australia
| | - Masahiro Hashizume
- Institute of Tropical Medicine, Nagasaki University , 1-12-4 Sakamoto, Nagasaki 852-8523 Japan
| | - Ho Kim
- Graduate School of Public Health, Seoul National University , Building 221, 1 Gwanak-ro, Gwanak-gu, Seoul, Korea 151-742
| | - Yasushi Honda
- University of Tsukuba , 1-1-1 Tennodai, Tsukuba, Ibaraki 305-0006, Japan
| | - Moses Pretrick
- Department of Health and Social Affairs , P.O. Box PS 70 Palikir, Pohnpei 96941, Federated States of Micronesia
| | - Steven Iddings
- World Health Organization , Sankat Chak Tomouk, Khan Daun Penh, Phnom Penh, Cambodia
| | - Boris Pavlin
- World Health Organization , 4th Floor, Aopi Centre, Waigani Drive, Port Moresby, Papua New Guinea
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